HealthTexas Medical Group of San Antonio
  • Medical Management-Grandstand
  • San Antonio, TX, USA
  • Full Time

LVN Managed Care

About HealthTexas Medical Group:

HealthTexas Medical Group of San Antonio is a primary care physician group that has become widely recognized as the industry leader in preventive primary health care. Founded in 1994, we operate 17 clinics and are committed to making a difference in the Greater San Antonio community. With more than 370 employees, we are consistently named San Antonio Express-News' Top Workplaces, Best Doctors in America, Texas Super Doctors, Top Doctors in San Antonio and Patients' Choice Award. If you are looking for a challenging and evolving, passionate work environment HealthTexas Medical Group of San Antonio may be the right place for you.

Our benefits:

  • Competitive salary
  • 15 days/ year paid-time off
  • Employer paid insurance for associate and competitive insurance premiums for dependents
  • Dental and vision insurance
  • Tuition reimbursement
  • 401(k) contributions and more!

About this role:

This licensed (LVN) professional will have strong managed care experience, team-player who is highly collaborative, and enjoys working independently. Your strongest skills will include attention to detail and critical thinking to help identify the criteria used to approve or deny referrals and to evaluate requested equipment or services based on diagnosis and past services that support Medicare Guidelines. Key responsibilities will specifically include:

  • Determining medical necessity of each referral request by applying appropriate medical criteria to first level reviews and utilizing approved evidenced based guidelines/criteria.
  • Utilizing decision making and critical thinking skills in the review and determination of coverage for medically necessary health care and services.
  • Referring cases to a review physician when the treatment request does not meet medical necessity per guidelines, or when guidelines are not available.
  • Establishing and maintaining professional rapport with healthcare team including providers, members, public agencies and other teams.
  • Demonstrating knowledge of CMS guidelines while performing job duties.

Required Education and skills:

  • Current unrestricted Texas State LVN License.
  • Minimum of 1 year experience with referral processes.
  • Knowledge of Medicare products and regulations for HMO and PPO.
  • Knowledge of Utilization Management and Case Management concepts preferred.
  • Experience or knowledge of audit processes.
  • Personal computer experience including Microsoft Word, Excel, PowerPoint and Outlook.
  • Experience with Milliman Care Guidelines preferred.
  • Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.
  • A self-starter who is successful with minimal supervision.
  • Exhibit leadership skills through performance, analytical thinking and process improvement.
  • Experience with electronic medical records.
HealthTexas Medical Group of San Antonio
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